Sociocultural Influences on Pain Assessment
Trial Summary
What is the purpose of this trial?
Objective The current proposal investigates behavioral, psychophysiological, and social processes that may help explain biases and disparate outcomes in pain. Health disparities, or health outcomes that adversely affect disadvantaged populations, are pervasive and apparent in many diseases and symptoms, including pain. Pain is the number one reason individuals seek medical treatment. Health disparities in pain encompass both differences in pain experience and treatment for pain. For instance, research indicates that Black individuals report increased pain and have reduced pain tolerance relative to White individuals, yet doctors are less likely to treat minority patients pain and underestimate their pain experience. This project aims to address this systemic discrepancy by focusing on interpersonal processes that may contribute to these disparities, including socially-relevant responses to pain (i.e. pain expression) and pain assessment (e.g. visual attention). The proposed research aims to determine whether the study of pain expressions and their assessment can yield insights on how social factors shape pain and its treatment. Further, we test the efficacy of potential interventions designed to improve accuracy and reduce biases in pain assessment. If successful, this work will form the foundation of a new research program that will link the field of pain research with the field of social neuroscience, and forge new insights on the critical problem of health disparities in pain. Study population We will accrue up to 700 total healthy volunteers to target 262 completers Design Our overall aim is to understand how social factors influence the assessment and management of pain, and to gain insight into psychosocial processes that may underlie health disparities in pain. We propose a series of studies designed to test these links. First, we will measure pain perception and physiological responses to painful stimuli in a diverse group of individuals to test for sociocultural and biological influences on pain and pain-related responses. In subsequent studies, new participants ("perceivers") will view images of these initial participants ("targets") and will provide estimates of 'targets' pain experience. We will measure a) whether perceivers can accurately estimate 'targets' pain experience; b) whether accuracy differs as a function of similarity between target and perceiver (ingroup vs outgroup); and c) whether individuals can improve accuracy through feedback. Outcome measures Primary outcome measures for all experiments will be decisions about pain (experienced by self or other) measured with visual analogue scales, reaction time, and/or categorical judgments (pain/no pain). We will also measure physiological responses (e.g., facial muscle response, skin conductance, pupil dilation) and brain responses using functional magnetic resonance imaging (fMRI) as secondary outcome measures. We will test whether pain and pain-related responses varies as a function of sociocultural/demographic factors (e.g. race, ethnicity, sex) and whether accuracy in assessing others pain is influenced by group similarity (i.e. ingroup vs. outgroup) and training (e.g. performance-related feedback)....
Do I need to stop taking my current medications for this trial?
Yes, if you regularly use prescription medications that significantly affect pain or heat perception, such as opiates, antidepressants, anticonvulsants, anxiolytics, hypnotics, antipsychotics, antimigraine agents, and muscle relaxants, you will need to stop taking them. However, using non-prescription pain relievers like ibuprofen or acetaminophen occasionally is allowed, as long as the last dose was not taken within 5 half-lives of testing.
What data supports the effectiveness of this treatment for pain assessment?
Is the treatment generally safe for humans?
The treatments mentioned, such as electrical stimulation and thermal stimulation, have been used safely in humans for pain management and research. Safety features are often included to prevent harm, like avoiding burns during thermal stimulation, and electrical stimulation is a well-accepted method for controlling pain.34678
How does the treatment in the trial differ from other pain treatments?
This treatment is unique because it combines cold water immersion, electric shock stimulation, and thermal stimulation to assess pain, which is different from standard pain treatments that often rely on medications or single-method therapies. The use of these physical stimuli allows researchers to explore how different cultural backgrounds might influence pain perception and response.13479
Research Team
Lauren Y Atlas, Ph.D.
Principal Investigator
National Center for Complementary and Integrative Health (NCCIH)
Eligibility Criteria
Healthy adults aged 18-60 who speak English fluently and can consent to participate are eligible for this study. Excluded are those with chronic pain conditions, certain medical issues affecting sensation or pain perception, employees of NCCIH and NIMH, non-US residents, and individuals taking specific prescription medications.Inclusion Criteria
Exclusion Criteria
Timeline
Screening
Participants are screened for eligibility to participate in the trial
Initial Assessment
Measure pain perception and physiological responses to painful stimuli in a diverse group of individuals
Perception Study
New participants view images of initial participants and provide estimates of their pain experience
Feedback and Training
Participants receive feedback on their performance to improve accuracy in pain assessment
Follow-up
Participants are monitored for accuracy and biases in pain assessment after interventions
Treatment Details
Interventions
- Cold water bath
- Electric shock stimulator
- Medoc thermal stimulator
- Pain assessment performance feedback
Find a Clinic Near You
Who Is Running the Clinical Trial?
National Center for Complementary and Integrative Health (NCCIH)
Lead Sponsor